September 01, 2014

The lessons of the Ebola outbreak

The world is fast learning lessons about how to combat the Ebola virus ravaging West Africa and yet not learning them fast enough. The virus, for which there is no known vaccine or antiviral, has now infected 3,069 people and killed 1,552 in Guinea, Liberia, Nigeria and Sierra Leone. Senegal has just reported its first case.

Overall, the pace is accelerating; nearly 40 percent of the cases have been in the last three weeks. The World Health Organization (WHO) predicted on Aug. 28 that eventually 20,000 may become infected.

Research to chart the genome of the virus has pinpointed its origin from a lone animal somewhere in West Africa in late December. From that moment on, the virus leapt from human to human by close contact with bodily fluids. The research underscores a basic fact about control: The best way is stopping contact with infected people. It has been a proven method for decades in smaller outbreaks.

However, this outbreak has been larger than all previous ones combined, and that is where the new lessons are emerging. West African nations, with fragile health-care systems and weak governments, had no experience in fighting the disease. Panic, suspicion and fear have overrun public health concerns. The lesson is that health authorities and governments need to pay attention to the attitudes of everyone, not just the infected. To calm the affected regions in the months ahead will require delivery of massive humanitarian aid to the living above and beyond the medical supplies required to treat the sick.

A related lesson is that, while isolation of the sick is critical, it can’t be imposed at the point of a gun. This has been on stark display in the West Point area of Monrovia, where the government decided to establish a quarantine enforced by the army and police. People desperate for work and food sought to evade it, and the quarantine began to leak — inevitably leading to spread of the virus. The cordon was taken down. Any effort at control can only work with the cooperation of those affected. It is far better to move the sick away from a city than to close off a whole section of it.

Finally, Ebola demands a massive, rapid reaction. The scale is important. The initial response was too hesitant despite warnings from Doctors Without Borders, which has been at the forefront of the struggle, and reports that the response is still lagging.

The just-approved WHO “road map” for the coming months points out that “a massively scaled and coordinated international response is needed” to fight such an outbreak, particularly at ports and in large cities. Such rapid-response surges may still be required in the months ahead.

Serious shortages of health-care workers, disrupted aviation links and lack of leadership, among other things, hinder the effort. The WHO has published a plan to get Ebola under control in six to nine months at a cost of $490 million.

But plans on paper are not enough. A concerted global effort to implement the road map is the only way to put out this fire.

Comments

The world is fast learning lessons about how to combat the Ebola virus ravaging West Africa and yet not learning them fast enough. The virus, for which there is no known vaccine or antiviral, has now infected 3,069 people and killed 1,552 in Guinea, Liberia, Nigeria and Sierra Leone. Senegal has just reported its first case.

Overall, the pace is accelerating; nearly 40 percent of the cases have been in the last three weeks. The World Health Organization (WHO) predicted on Aug. 28 that eventually 20,000 may become infected.

Research to chart the genome of the virus has pinpointed its origin from a lone animal somewhere in West Africa in late December. From that moment on, the virus leapt from human to human by close contact with bodily fluids. The research underscores a basic fact about control: The best way is stopping contact with infected people. It has been a proven method for decades in smaller outbreaks.

However, this outbreak has been larger than all previous ones combined, and that is where the new lessons are emerging. West African nations, with fragile health-care systems and weak governments, had no experience in fighting the disease. Panic, suspicion and fear have overrun public health concerns. The lesson is that health authorities and governments need to pay attention to the attitudes of everyone, not just the infected. To calm the affected regions in the months ahead will require delivery of massive humanitarian aid to the living above and beyond the medical supplies required to treat the sick.

A related lesson is that, while isolation of the sick is critical, it can’t be imposed at the point of a gun. This has been on stark display in the West Point area of Monrovia, where the government decided to establish a quarantine enforced by the army and police. People desperate for work and food sought to evade it, and the quarantine began to leak — inevitably leading to spread of the virus. The cordon was taken down. Any effort at control can only work with the cooperation of those affected. It is far better to move the sick away from a city than to close off a whole section of it.

Finally, Ebola demands a massive, rapid reaction. The scale is important. The initial response was too hesitant despite warnings from Doctors Without Borders, which has been at the forefront of the struggle, and reports that the response is still lagging.

The just-approved WHO “road map” for the coming months points out that “a massively scaled and coordinated international response is needed” to fight such an outbreak, particularly at ports and in large cities. Such rapid-response surges may still be required in the months ahead.

Serious shortages of health-care workers, disrupted aviation links and lack of leadership, among other things, hinder the effort. The WHO has published a plan to get Ebola under control in six to nine months at a cost of $490 million.

But plans on paper are not enough. A concerted global effort to implement the road map is the only way to put out this fire.